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Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders

Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies.

Case Study 1:

Clay is a 7-year-old male who presents in your office with complaints of right thigh pain and a limp. The pain began approximately 1 week ago and has progressively worsened. There is no history of trauma. Physical examination is negative except for pain with flexion and internal rotation of the right hip and limited abduction of the right hip. Limb lengths are equal.

Case Study 2:

Trevon is an 18-month-old with a 3-day history of upper-respiratory-type symptoms that have progressively worsened over the last 8 hours. His immunizations are up to date. Mom states he spiked a fever to 103.2°F this morning and he has become increasingly fussy. He vomited after drinking a cup of juice this afternoon and has refused PO fluids since then. Pertinent physical exam findings include negative abdominal exam, marked irritability with inconsolable crying, and he cries louder with pupil examination and fights head and neck assessment. You are unable to elicit Kernig’s or Brudzinski’s signs due to patient noncompliance.

Case Study 3:

Molly is a 12-year-old who comes to your office after hitting her head on the ground during a soccer game. Her mother reports that she did not lose consciousness, but that she seems “loopy” and doesn’t remember what happened immediately following her fall. She was injured when she collided with another player and fell backward, striking her head on the ground. She has no vomiting and denies diplopia but complains of significant headache. Physical examination is negative except for the presence of slight nystagmus. All other neurologic findings including fundoscopic examination are normal.

To prepare:

  • Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text.
  • Review and select one of the three provided case studies. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

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